LCD Reference ArticleBilling and Coding Article
A56420
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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.
Document Note
Note History
Contractor Information
Article Information
General Information
Source Article ID
N/A
Article ID
A56420
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Frequency of Laboratory Tests
Article Type
Billing and Coding
Original Effective Date
03/28/2019
Revision Effective Date
01/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is notrecommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services.The AMA assumes no liability for data contained or not contained herein. Current Dental Terminology © 2023 American Dental Association. All rights reserved. Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission.No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may becopied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes anddescriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative workwithout the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816. Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes,resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions;and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is onlyauthorized with an express license from the American Hospital Association.The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness oraccuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in thepreparation of this material, or the analysis of information provided in the material. The views and/or positionspresented in the material do not necessarily represent the views of the AHA. CMS and its products and services arenot endorsed by the AHA or any of its affiliates.
CMS National Coverage Policy
Please refer to the Local Coverage Determination (LCD) L35099, Frequency of Laboratory Tests.
Article Guidance
Article Text Refer to the Novitas Local Coverage Determination (LCD) L35099, Frequency of Laboratory Tests, for reasonable and necessary requirements and frequency limitations. The Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) code(s) may be subject to National Correct Coding Initiative (NCCI) edits. This information does not take precedence over NCCI edits. Per CMS Medicare Learning Network (MLN) Medicare Matters number MM8863, the use of NCCI-associated modifiers should NOT be used to bypass a procedure-to-procedure (PTP) edit unless the proper criteria for use of the modifier are met. Documentation in the medical record must satisfy the criteria required by any NCCI-associated modifier that is used. Please refer to NCCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare. Refer to the NCDs for the procedure code list of ICD-10-CM codes that are considered covered by Medicare at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html
Response To Comments
| Number | Comment | Response |
|---|---|---|
| 1 |
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Coding Information
Bill Type Codes
| Code | Description |
|---|---|
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 014x | Hospital - Laboratory Services Provided to Non-patients |
| 018x | Hospital - Swing Beds |
| 021x | Skilled Nursing - Inpatient (Including Medicare Part A) |
| 022x | Skilled Nursing - Inpatient (Medicare Part B only) |
| 023x | Skilled Nursing - Outpatient |
| 071x | Clinic - Rural Health |
| 072x | Clinic - Hospital Based or Independent Renal Dialysis Center |
| 085x | Critical Access Hospital |
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Revenue Codes
| Code | Description |
|---|---|
| 030X | Laboratory - General Classification |
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CPT/HCPCS Codes
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Group 1
(13 Codes)
Group 1 Paragraph Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.
| Code | Description |
|---|---|
| 80061 | Lipid panel |
| 82465 | Assay bld/serum cholesterol |
| 82948 | Reagent strip/blood glucose |
| 82962 | Glucose blood test |
| 82985 | Assay of glycated protein |
| 83036 | Hemoglobin glycosylated a1c |
| 83718 | Assay of lipoprotein |
| 83721 | Assay of blood lipoprotein |
| 84436 | Assay of total thyroxine |
| 84439 | Assay of free thyroxine |
| 84443 | Assay thyroid stim hormone |
| 84478 | Assay of triglycerides |
| 84479 | Assay of thyroid (t3 or t4) |
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CPT/HCPCS Modifiers
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Group 1
Group 1 Paragraph N/A
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N/A
ICD-10-CM Codes that Support Medical Necessity
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Group 1
(1 Code)
Group 1 Paragraph It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted. Medicare is establishing the following limited coverage for CPT/HCPCS codes 80061, 82465, 82948, 82962, 82985, 83036, 83718, 83721, 84436, 84439, 84443, 84478 and 84479: Refer to the NCDs for the procedure code list of ICD-10-CM codes that are covered by Medicare at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html
| Code | Description |
|---|---|
| XX000 | Not Applicable |
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ICD-10-CM Codes that DO NOT Support Medical Necessity
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Group 1
(1 Code)
Group 1 Paragraph All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article. Refer to the NCDs for the procedure code list of ICD-10-CM codes that are considered non-covered or do not support medical necessity at: https://www.cms.gov/Medicare/Coverage/CoverageGenInfo/LabNCDsICD10.html
| Code | Description |
|---|---|
| XX000 | Not Applicable |
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ICD-10-PCS Codes
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Group 1
Group 1 Paragraph N/A
N/A
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Additional ICD-10 Information
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Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typicallyused to report this service. Absence of a Bill Type does not guarantee that thearticle does not apply to that Bill Type. Complete absence of all Bill Types indicatesthat coverage is not influenced by Bill Type and the article should be assumed toapply equally to all claims.
| Code | Description |
|---|---|
| 012x | Hospital Inpatient (Medicare Part B only) |
| 013x | Hospital Outpatient |
| 014x | Hospital - Laboratory Services Provided to Non-patients |
| 018x | Hospital - Swing Beds |
| 021x | Skilled Nursing - Inpatient (Including Medicare Part A) |
| 022x | Skilled Nursing - Inpatient (Medicare Part B only) |
| 023x | Skilled Nursing - Outpatient |
| 071x | Clinic - Rural Health |
| 072x | Clinic - Hospital Based or Independent Renal Dialysis Center |
| 085x | Critical Access Hospital |
N/A
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under otherRevenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicatesthat coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.
Note: The contractor has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this article. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, for further guidance.
| Code | Description |
|---|---|
| 030X | Laboratory - General Classification |
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Other Coding Information
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Group 1
Group 1 Paragraph N/A
N/A
N/A
Coding Table Information
Excluded CPT/HCPCS Codes - Table Format
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|---|---|---|---|---|
| N/A | N/A |
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
| Code | Descriptor Generic Name | Descriptor Brand Name | Exclusion Effective Date | Exclusion End Date | Reason for Exclusion |
|---|
N/A
Revision History Information
| Revision History Date | Revision History Number | Revision History Explanation |
|---|---|---|
| 01/01/2023 | R2 | Article revised and published on 01/26/2023 effective for dates of service on and after 01/01/2023 to reflect the Annual HCPCS/CPT Code Updates. For the following CPT code either the short description and/or the long description was changed. Depending on which description is used in this article, there may not be any change in how the code displays: 83036 in Group 1 Codes. |
| 11/07/2019 | R1 | Article revised and published on 11/07/2019. Consistent with CMS Change Request 10901, all coding information from the related LCD has been placed into this article. Due to system changes, the order of the Coding Section has been revised and new sections for CPT/HCPCS Modifiers and Other Coding Information have been added. |
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Associated Documents
Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L35099 - Frequency of Laboratory Tests
Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
| Updated On | Effective Dates | Status | |
|---|---|---|---|
| 01/20/2023 | 01/01/2023 - N/A | Currently in Effect | You are here |
| Some older versions have been archived. Please visit theMCD Archive Site to retrieve them. | |||
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